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Children's Hospital at Dartmouth Hitchcock (CHad)
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Brachial Plexus Injuries

Overview

The Brachial Plexus Clinic of the Dartmouth-Hitchcock Medical Center and the Children's Hospital at Dartmouth-Hitchcock offers multidisciplinary services aimed at treating brachial plexus disorders in both children and adults. As one of few centers in the country with expertise in brachial plexus disorders, our goal is to provide comprehensive surgical and medical treatment in a multidisciplinary setting. Our team includes specialists in pediatric and adult neurosurgery, micro/hand surgery, plastic and reconstructive surgery, pediatric and adult neurology, and physical therapy. All of our team members meet with each patient during the appointment, maximizing the efficiency of the clinic and facilitating collaboration among the different specialists.

We offer treatment of infants with birth-related brachial plexus injuries, older children and adults with traumatic brachial plexus injuries, tumors, and other disorders of the brachial plexus.

Anatomy

The brachial plexus is composed of five large nerves that carry information back and forth from the brain and spinal cord to the shoulder, arm, and hand. Damage to these nerves can cause loss of sensation or weakness in the shoulder, arm, or hand depending on what nerve is injured.

Brachial plexus injuries in infants

Brachial plexus injuries in infants are typically a result of traction on the nerves going to the arm during birth. It is one of the most common injuries during the birthing process. The injury may involve one or more of the nerves that go to the shoulder, arm, or hand. The injury may be a mild stretch injury from which most children will make a very good recovery to more severe injuries from which children are much less likely to recover. Infants with brachial plexus injuries should begin physical therapy shortly after birth.

At 1 month of age, the patient is seen for an initial evaluation by our multidisciplinary team. At 3 months of age, the patient is seen again and evaluated for any signs of improvement. In most cases, children that show significant improvement at 3 months of age will not require surgery. In children that have shown no signs of improvement by 3 to 6 months of age, special testing including electromyography (EMG), magnetic resonance imaging (MRI), or computed tomography (CT) myelogram may be done to guide management.

If surgery is recommended, it is typically performed between 4 and 9 months of age. The operation is done under general anesthesia and takes between 5 to 10 hours. Children typically spend 1 to 2 nights in the hospital after the surgery. The child's arm may be supported by a special sling, which the child will wear for 1 to 3 months after the surgery to allow the nerves to heal. Physical therapy typically begins about 2 weeks after surgery and lasts for up to 3 years after surgery. Signs of recovery typically occur anywhere from 4 to 6 months after surgery and may continue up until 3 years after surgery.

Brachial plexus injuries in older children and adults

Brachial plexus injuries in older children and adults are most commonly due to trauma caused by automobile, motorcycle, or bicycle accidents. In the case of an older child or adult with a brachial plexus injury, we prefer to evaluate the patient shortly after injury at which time a detailed motor and sensory examination of the arm is performed. Depending on the type and nature of the injury, surgery may be offered at that time or more typically, after a 3 to 6-month period of recovery. At that time, additional testing including EMG, MRI, and/or CT myelogram may be performed to guide management.

If surgery is recommended, it is typically done between 3 and 6 months after injury. The operation typically takes between 5 and 10 hours. Most patients spend 1 or 2 nights in the hospital after surgery. Depending on the type of operation, a sling or splint may be used to limit arm motion for the first several weeks after the surgery. Physical therapy is started 2 weeks post-operatively and continues for 2 to 3 years after the surgery.


Page reviewed on: Nov 19, 2009

Page reviewed by: Susan R. Durham, MD, MS

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